The impact of pediatric constipation on appendicitis: a prospective birth cohort in the Japan Environment and Children’s Study

TL;DR

This study explores whether constipation in young children might be linked to a higher risk of appendicitis, using data from a large Japanese birth cohort.

Contribution

The study is one of the first to explore the potential link between childhood constipation and appendicitis in a large, population-based cohort.

Findings

156 cases of appendicitis were identified among 64,772 children aged 3–4 years.

Children with constipation showed a trend toward increased appendicitis risk, though results were not statistically significant.

Abstract

This study aimed to examine the association between constipation and appendicitis in children using data from a nationwide birth cohort, the Japan Environment and Children's Study (JECS).

Data were obtained from 64,772 children and their mothers participating in JECS, which included over 100,000 pregnancies across 15 regional centres in Japan. Pediatric constipation was assessed at age three using the Rome III criteria, while appendicitis cases were identified between ages three to four. Logistic regression analyses, including univariable and multivariable models, were conducted to evaluate associations. Additional analyses were stratified by sex.

Among the 64,772 children analyzed, 156 cases of appendicitis were identified between the ages of 3 and 4 years. Logistic regression suggested a possible association between constipation and an increased risk of appendicitis (univariable odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.87–2.10; multivariable OR: 1.36, 95% CI: 0.86–2.06). Although the associations did not reach statistical significance, the point estimates consistently indicated a trend toward increased risk.

Although our analyses of children aged 3–4 years did not yield statistically significant associations, the observed trends may suggest a potential link between constipation and appendicitis. These findings should be interpreted only as exploratory, and further studies in different age groups, including older children and adults, are warranted to confirm or refute this possible association.

The online version contains supplementary material available at 10.1186/s12887-025-06263-7.

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